Treatment of Candidemia

Immediate Actions Required

The Infectious Diseases Society of America recommends starting antifungal treatment within 24 hours of blood culture positivity, as delays are associated with increased mortality 1, 2
The Infectious Diseases Society of America suggests removing all intravascular catheters if possible, as catheter retention significantly worsens outcomes in candidemia 1, 3
Obtain daily or every-other-day follow-up blood cultures until clearance is documented, as recommended by the Infectious Diseases Society of America 1, 2

The Infectious Diseases Society of America recommends echinocandin therapy as first-line treatment for most patients, particularly those who are moderately to severely ill or have recent azole exposure 1, 2
For nonneutropenic adults, the American College of Clinical Pharmacy recommends caspofungin 70 mg loading dose, then 50 mg daily, micafungin 100 mg daily, or anidulafungin 200 mg loading dose, then 100 mg daily 4
For neutropenic patients, the Infectious Diseases Society of America recommends fluconazole 800 mg loading dose, then 400 mg daily, or echinocandin therapy 1, 2

For Candida glabrata, the Infectious Diseases Society of America recommends always using echinocandin as first-line therapy due to frequent reduced fluconazole susceptibility 4
For Candida albicans and fluconazole-susceptible species, the Infectious Diseases Society of America suggests fluconazole 400 mg daily is equivalent to amphotericin B for susceptible strains 3

The Infectious Diseases Society of America recommends treating for 14 days after the first negative blood culture result and resolution of all signs and symptoms attributable to candidemia 1, 2, 4

The Infectious Diseases Society of America recommends performing dilated fundoscopic examination on all patients to exclude Candida endophthalmitis 1, 2, 4
The Infectious Diseases Society of America suggests removing all central venous catheters in candidemia cases, as catheter retention worsens outcomes in all prospective studies 3

The Infectious Diseases Society of America recommends not delaying antifungal initiation beyond 24 hours, as delays increase mortality 1, 2
The Infectious Diseases Society of America suggests not retaining central venous catheters, as this is associated with treatment failure 3
The Infectious Diseases Society of America recommends not stopping therapy prematurely, but continuing for full 14 days after documented clearance 1, 2, 4